When I heard about a cosmetic procedure that freezes your fat in a single afternoon, I thought it was just another brazen entry into a crowded market of slogans and snake oil. Even the name sets off quackery alarm bells: CoolSculpting®.

The CoolSculpting procedure is like something Margaret Atwood would hallucinate on an Olestra-induced nightmare vision quest. When you go in, doctors clamp your "problem area" flab in between two cooling plates. Gel pads are placed over this flab to prevent skin damage as the −7C cooling plates lower the temperature of fat cells gradually. Fat cells freeze more quickly than skin cells, so the thermoelectric cooling is regulated to be cold enough to kill fat, but not cold enough to give people frostbite. After an hour session, the cold flab is often massaged, and that's it.

After the cooling process kills the fat cells, they're attacked by white blood cells, which convert them to triglycerides that are then metabolised by the liver and eliminated. Some doctors say that patients pass the fat out through urine, not turds, but nobody knows exactly. It's a gross mystery.

No skin is cut, no blood is shed, you can go to work the same day, and you're marginally closer to fulfilling an arbitrary standard of beauty in as much time as it takes to get your teeth cleaned. Once killed, fat cells get "naturally eliminated from the body," which is a gussied-up way to say you poo them. A quick fix! No diet, no exercise! Poo!

I know. It sounds like pseudoscience for the desperate, like something Dr Oz would enthusiastically endorse. In fact, Dr Oz isa fan of CoolSculpting and Cryolipolysis®, its trademarked freezing process. But the process is approved by the Food and Drug Administration and performed at cosmetic procedure clinics all over the US, and it's based on legitimately promising research.

The CoolSculpting origin story is as weird as how it works. The idea started with Dr Rox Anderson and Dr Dieter Manstein, dermatologists and researchers (anyone involved with CoolSculpting will make sure to mention that they're Harvard-affiliated). The duo found out you could freeze fat from looking at how kids who suck on Popsicles can develop dimples from where the Popsicle hits their cheek. The cold-treat-induced dimpling is called "Popsicle panniculitis", which sounds alarmingly fake but is an acknowledged medical condition.

The medical device company behind the CoolSculping device, Zeltiq, tested Anderson and Manstein's hypothesis on Black Yucatan pigs, creating a process to stimulate "controlled cell death" that crystallises the lipids in fat cells while leaving other body tissue intact.

Paying for the privilege of discharging your flab to the toilet is not cheap, but people love to shit their fat. A recent American Society of Dermatologic Surgery survey ranked it as the most common body-sculpting procedure. Doctors have carried out over 1.5 million sessions with Zeltiq's homebrewed flab necrosis treatment since it debuted in 2010 — at anywhere from $US400 to $US1800 per session.

"We have 17 machines and have done over 15,000 treatments," Dr Grant Stevens, the medical director of southern California's Marina Plastic Surgery, told me. That's at a single clinic. So much poo fat.

People have been trying to create non-surgical devices to banish fat for decades. Vibrating weight loss fat belts have been around since the 1850s — this is not a recent fixation. They gained popularity in the 1960s, and were sometimes advertised to work by jiggling the body until fat cells loosened up, for "spot reduction." Ab toning belts are their modern ancestor, and while they're approved by the FDA for rehabilitating atrophied muscles, they're also often marketed as a fitness tool. And new gadgets and procedures keep cropping up, like Vanquish, a Czech-based body-shaping process that uses "deep-tissue heating" to target and kill fat cells, a sort of reverse CoolSculpting.

And the idea of using cold to kill cells certainly wasn't pioneered by CoolSculpting. Cryosurgery, where doctors apply intense cold to an area of the body, is a type of cancer treatment. It's a common way to treat both internal and external tumours by applying liquid nitrogen to the tumours and precancerous growths.

So this is more of a novel and specific application of an already accepted idea, albeit one kooky enough to make doctors sceptical.

"Initially I was very sceptical. Plastic surgery is so often full of unsubstantiated claims that I was naturally reluctant to believe in something that seemed too good to be true," Dr Frank Lista, founder of Toronto's Plastic Surgery Clinic, told me. "While not a panacea for fat reduction, it has proved to be a very interesting technology." The Plastic Surgery Clinic now lists itself as Toronto's "premiere CoolSculpting centre."

Here's the Chub Rub

CoolSculpting is shrewdly marketed, but many doctors who offer it are quick to point out it's not for all-over weight loss. You can freeze your fat off and poo it out, but only a tiny bit at a time, and on certain areas of the body, and on certain body types. There are a lot of caveats.

Since the amount of fat that dies is so small, it's not likely to result in a change on the scale, and patients can only expect 20-25 per cent "permanent reduction in fat" for the small frozen area. This means that, even when it works as advertised, the treatment results in a subtle change in shape. The results usually only appear after a few weeks to a few months. Patients lose, on average, around 40 cubic centimetres of fat, according to a study conducted at the Massachusetts General Hospital. One pound is around 450 cc's, so a 40 cc loss is minuscule.

"I did it several times and it was quite expensive for the amount of reduction I got," CoolSculpting patient Sherrie Barrick told me. "Overall weight loss is a better option. I am still somewhat happy with my results because I look better at a higher weight than I used to."

To offer a comparison, people generally take daily dumps that weigh 1 to 4 pounds, so people can take a regular shit and lose substantially more weight than they do in a CoolSculpting session. That's an expensive bathroom break.

also ahhhhhhhhhh it looks like this

Looking at the cosmetic surgery community RealSelf, where people discuss the results of their cosmetic procedures, CoolSculpting has mediocre feedback, with a 63% approval rating and many people claiming their results are negligible. Others report painful conditions like hyperplasia, which is an unintended fat increase that can only be dealt with surgically.

Some cosmetic surgery providers do not offer CoolSculpting, citing how ineffective it is compared to traditional liposuction, plus the lack of research on its long-term effects. Other doctors are sketched out by Zeltiq as a company. Zeltiq has been criticised by some clinicians for installing a tracking software called CoolConnect on its machines so it can directly collect patient data. Zeltiq argues that since the data is generic and doesn't identify patients, it's kosher, but the idea that the machines collect information without going through the doctors isn't sitting well with some practitioners.

Yet everyone I actually talked to through RealSelf said they were mostly happy with the procedure, including Nevada-area mother Airene Haze, who initially wasn't sure if it worked. Despite its limits, and the simple fact that it sounds ridiculous, this is something people want to do.

CoolSculpting peddles a dream of painlessly getting a better body, of literally zapping problems away with medical technology. It's easy to be cynical about Zeltiq, and the entire cosmetic weight loss industry, and we should be. But in this case, the bizarre science works. You can freeze your fat and poo it out.

Pictures: Jim Cooke, screenshot from Zeltiq/Oxnard Obgyn

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